Dr. Josep Figueras:

Prioritising. Yes, I am sorry.

Linked to that, let us go quickly to the skill mix. We do not know the outcome based on that. The same is so with the question about the beds. It is frustrating. When I started in my career, I got a scholarship. I come from Spain. I got my first scholarship from the regional government when I was in my mid-20s to study in the UK and they said that they would pay for my scholarship but I would have to come back and tell them how many beds they needed. They said that in the UK, they know everything and I would have to tell them that. It sounds silly, and I thought I could find out. It took years to understand there is no such thing as the right number of beds or the right skill mix, but there are principles.

It is not about the number of beds; it is about how to use them. It is not about the beds. The number of beds will depend on how primary health care is working. It will depend on day-care surgery. I must say I look at some of Ireland's numbers and if I am not mistaken, there has been a significant increase in the use of day-care surgery. That is worthy of congratulations. A lot has to do with the way one pays. The committee has not asked me that but let me say it anyway. If one pays in a way where there is a greater incentive for day-care surgery and if one pays in a way where there is greater incentive for primary care, one can resolve some of one's problems at hospitals level.

As for the number of beds, I have data here. It is not in one of the slides - my fellow forgot to put it there. However, I can say it by heart and if the committee gives me a minute, I can find the slide on my computer. I agree that Ireland has one of the lowest number among countries in Europe. In the UK, for instance, England's is lower. That does not mean they are far worse in their use of beds. It is really the way one uses these beds, turnover and continuity of care. The problem of Ireland's waiting times is not the number of beds, I would say. It is much more how one uses them, how patients can be discharged into community care, how one pays for that, how one further uses day-care surgery, how efficient one is and how one networks these hospitals rather than, necessarily, the number of beds. I agree Ireland's number is low in comparative terms but I would not say that is necessarily the problem, although I do not know the country well enough. I have not had the opportunity to look at it recently.

On the question of the skill mix between doctors and nurses, it all depends how one uses the doctors and nurses. One can have lots of nurses and fewer doctors, and say: "You see, I am more cost-effective." If one uses the nurses to do certain jobs, one is not that cost-effective. With more doctors, it depends on how one uses the doctors. In some countries in Europe, there are paediatricians who weigh children as they operate alone. That is not cost-effective. That is wasting resources. I do not have this data. No one has it. We know that if one looks on the nurses and doctors as the basic level, there is much more that one can do. When one looks at nurses, it is fascinating that one says the problem is doctors do not accept nurses in the jobs of doctors. One of the problems when we suggest a skill mix is the politics of doctors accepting nurses in new roles but what is interesting is that when nurses acquire these new roles, the nurses do not accept nurses to take some of the roles. One of the issues of skill mix is the political debate and how one brings the profession to understand it is not a threat to them, but rather a way to make the cost effective. Surely that paediatrician prefers to see children rather than weighing them, but the paediatrician is worried about his or her income. One should find a way to pay him or her appropriately. Whatever is appropriate is not a debate - the committee will be aware that Ireland, according to OECD data, has the highest paid doctors in Europe. I note there is much debate about whether the numbers are fine or not, but that is what the OECD says. Maybe the committee will invite the OECD. I will tell the committee where the numbers came from. I do not have the details of whether that skill mix has better outcomes or not, but certainty a better skill mix with nurses doing more jobs that belong now to doctors is bound to increase cost-effectiveness and quality of the system.

I am getting there. I am really sorry.